A twice-weekly syndicated newspaper column on California public affairs.

Thursday, December 5, 2013

NEW ERA LOOMS FOR CALIFORNIA MEDICINE

CALIFORNIA
FOCUS
FOR RELEASE: FRIDAY, DECEMBER 20, 2013, OR THEREAFTER

BY THOMAS D. ELIAS“NEW ERA LOOMS FOR CALIFORNIA
MEDICINE”

As the new year approaches, a new era
also looms for California medicine, and the changes are not due only to the
Affordable Health Care Act, better known as Obamacare.

Other big changes will come as
pharmacists expand their role in patient care and nurse practitioners, nurse
midwives and physican assistants begin performing first-trimester abortions –
unless a current attempt to qualify a referendum to stop the abortion expansion
qualifies for next November’s ballot and delays it by a year.

Even larger changes may come in 2015,
depending on how the newly expanded roles for non-physicians work out.

Although he did not carry the
abortion-related bill, the effort to bestow new privileges on non-doctors is
spearheaded by Democratic state Sen. Ed Hernandez of West Covina, who achieved
only part of his goals this year. Hernandez, an optometrist, also sought wider
privileges for both nurse practitioners and his own profession.

But most MDs opposed the changes, with
the California Medical Association managing to stymie much of what Hernandez
sought. He has said he’ll be back with similar measures next year.

How well they do will likely be tied
closely to whether problems crop up in the expanded pharmacist roles and the
abortion changes.

With the new law, pharmacists soon
will be administering drugs and vaccinations directly to their customers (they
already do some vaccinations), conducting patient assessments, ordering tests
and overseeing drug regimens. The shift is meant partly to compensate for a
shortage of primary care doctors to handle the increased patient load Obamacare
will bring.

It represents a sea change. Not many
years ago, pharmacists couldn’t even give flu shots. Now thousands of
pharmacies across California post prominent signs inside and outside their
stores offering those vaccinations almost year-‘round.

That’s worked out fine, relieving
doctors of a routine chore, making vaccinations more convenient for patients
and producing virtually no negative incidents. If pharmacists do as well with
their new roles, it’s a virtual certainty optometrists and nurse practitioners
will also see theirs expand.

And the odds are things will work out
fine, although the occasional malpractice claim is to be expected.

Less certain is what might happen to
women getting first-trimester vacuum aspiration abortions from non-physicians
who have received special training.

Some liberal groups were delighted
with the change because it essentially treats abortions like many other medical
procedures. “The fact that abortion is singled out for special consideration
(in other states) is a relic of the days when it was a felony. It’s a
reflection of where this country is politically,” ACLU spokeswoman Margaret
Crosby told a reporter.

Pro-life activists, however, see the
change as a trivialization of pregnancy. From now on, California Pro-Life
Council director Brian John complained, “animals will have more dignity under
California law than human beings.”

One thing for sure: If medical
complications crop up in a significant number of cases, early abortions will go
back to being doctors-only affairs.

But that doesn’t seem likely, one
reason this bill passed and won Gov. Jerry Brown’s signature. That guess is
based on a UC San Francisco study of 11,000 procedures over the last five
years, which found virtually no difference in the prevalence of complications
between early abortions done by doctors and those carried out by skilled
non-physicians.

Researchers conducted the study, which
involved more than 5,000 non-physician abortions, using a little-known
provision of California law allowing health care professionals other than MDs
to take part in some pilot projects.

In a state where teenage pregnancies
are rampant (even if reduced slightly from a decade ago), there is little doubt
that, barring the possible referendum reversing it, the new law will make
abortion more accessible.

Even so, it’s highly unlikely this
will lead to change in other states, as many previous California laws have
done. This state is far to the left of many others.

But the increased responsibility given
pharmacists is something that could spread now that California has joined more
than a dozen other states in granting it. More loosening up in health care will
depend on how the druggists do next year.

-30-
Email Thomas Elias at tdelias@aol.com. His book,
"The Burzynski Breakthrough, The Most Promising Cancer Treatment and the
Government’s Campaign to Squelch It," is now available in a soft cover
fourth edition. For more Elias columns, visit www.californiafocus.net

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About Me

Thomas Elias writes the syndicated California Focus column, appearing twice weekly in 88 newspapers around California, with circulation over 2.2 million.
He has won numerous awards from organizations like the National Headliners Club, the California Newspaper Publishers Association, the Los Angeles Press Club, and the California Taxpayers Association. He has been nominated three times for the Pulitzer Prize in distinguished commentary.
Elias is the author of two books, "The Burzynski Breakthrough: The Most Promising Cancer Treatment and the Government's Campaign to Squelch It" (now in its third edition; also published in Japanese and recently optioned for a television movie) and "The Simpson Trial in Black and White," co-authored with the late Dennis Schatzman.